New Patient Registration

As of May 15, 2010, Queenan Family Medicine and Maternity Care will no longer be accepting new patient registrations, other than those of direct family members of existing patients of the practice.


To register as a new patient with Queenan Family Medicine and Maternity Care, please complete the following steps:


1. Fill out the registration form below, and Dr. Queenan will send you a confirmation email within 2-3 days.

NEW PATIENT REGISTRATION FORM


First Name:


Last Name:


Date of Birth (MM/DD/YYYY):


Insurance:


Mailing Address:


Phone Number:


Email Address (if applicable):


Questions or Comments:

   

2. Please schedule your first appointment using the online appointment scheduler Appointment Quest. Your registration confirmation email will include information on how to create your account in this program and schedule your first appointment. If you have any trouble making an appointment online, please contact Dr. Queenan by phone (888.494.3064) or email, and Dr Queenan will be happy to assist you.

3. Then, please complete the following forms prior to your first appointment:

A. Please click here New Patient Questionnaire to complete this health history questionnaire in its entirety in order to maximize our time together in your first visit. If you do not have convenient access to the internet, please download, print, and fill out the printable version of the secure New Patient Questionnaire below and bring it to your first appointment. Your answers to this questionnaire are confidential and will not be shared. Please try to provide as much detail as possible. Thank you for your time.

Download printable New Patient Questionnaire here

B. Thoroughly review the Office Policies and HIPAA Privacy Policy for the practice. Please contact Dr. Queenan with any questions or concerns about these policies. When you are comfortable with these policies, please download, print, and sign the Signature Page with e-mail policy below, and bring this with you to your first appointment.

Download printable Signature Page with e-mail policy here

C. Please download, print, sign, and send the Medical Record Release form below to any provider who has medical records of yours that you would like Dr. Queenan to be able to review for your care, including your former primary care doctor.

Download printable Release of Medical Records here

Important: You may want to inquire about fees associated with a record transfer. If costs are prohibitive, please contact Dr. Queenan to determine which elements of your medical record are most valuable. Records received by Dr. Queenan can be returned to you after processing if desired.

4. Health insurance/payment issues:

Dr. Queenan has contracts with Excellus BCBS, MVP, Aetna, and most United Health Care plans. She also accepts Medicare and Medicaid-managed care (Blue Choice Option and MVP Option). If you have any questions about whether Dr. Queenan is a participating provider with your insurance, please call the customer service phone number on the back of your card or contact Dr. Queenan directly

If required by your insurance company, be sure to designate Dr. Queenan as your Primary Care Provider in order to make sure that your visit will be appropriately covered.

For patients without health insurance, Dr. Queenan offers discounts for prompt payment; please contact her for further details. Credit card, Debit card, cash, and check are accepted.

If you have any questions, please contact Dr. Queenan by phone (888.494.3064) or email.

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© 2010 Emily Queenan MD